Screening by optometrists is better than screening by fundus photography

EDITOR—We have concerns about the National Screening Committee's recommendations for a risk reduction programme for diabetic retinopathy, in which digital photography is the screening method of choice.1 The gold standard for fundus examination is slit lamp biomicroscopy performed by an experienced ophthalmologist; this is the standard on which treatment decisions are made. The same technique used by other trained professionals in a screening environment duplicates the gold standard.

Slit lamp biomicroscopy has advantages over fundus photography. It offers a stereoscopic view, thereby detecting diffuse macular oedema that is missed by photography. The entire post-equatorial retina can be examined with this technique, whereas even seven-field photography misses about 17% of the retina.2

The technical failure …